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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005893
Report Date: 02/28/2024
Date Signed: 02/28/2024 04:00:36 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/21/2024 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240221094756
FACILITY NAME:A MISSION FOR MICHAELFACILITY NUMBER:
306005893
ADMINISTRATOR:COKE, BETH PH.DFACILITY TYPE:
772
ADDRESS:28334 PASEO MICHELLETELEPHONE:
(949) 371-3857
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:6CENSUS: 4DATE:
02/28/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Rey-Philip Genaldo, Clinical Director
Christina Kayanan, Executive Director
TIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Facility does not have enough food for clients in care

Staff are serving spoiled food to clients

Client medication was not refilled timely
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced visit to the facility for the purpose of initiating the investigation into the allegations listed above. LPA was greeted and granted entry by facility staff after introducing himself and stating the purpose of the visit. The three allegations were then listed.

LPA accompanied by facility staff conducted a tour of the facility's kitchen and additional food storage located in the garage. An adequate supply of two days of perishables and seven days of non-perishable food could be observed. There is also fresh fruit and vegetables available. Lunches and dinners and being brought out from a catering service. All food items are verified to be dated and marked for expiration. Additionally, LPA requested, obtained and reviewed client records maintained at the facility and conducted three client and five staff interviews.

CONTINUED ON FORM LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20240221094756
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: A MISSION FOR MICHAEL
FACILITY NUMBER: 306005893
VISIT DATE: 02/28/2024
NARRATIVE
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CONTINUED FROM FORM LIC9099
Regarding the allegation that Facility does not have enough food for clients in care, the following has been concluded: Based on observation conducted during the tour of the physical plant and interviews conducted, LPA determined that groceries were being provided at least weekly on Tuesdays or Wednesdays by the facility's Residential Supervisor on the basis of requests expressed during a meeting with the clients held every Sunday. A sufficient supply of food was observed during the visit and groceries were seen being brought by the Residential Supervisor during the visit. Two of the interviews conducted expressed concern about sufficient supply being brought in, however other interviews appeared to confirm that supplemental orders and other measures were in place to ensure a sufficient supply of nutrition for the clients in care.

Regarding the allegation that Staff are serving spoiled food to clients, the following has been concluded: Interviews and observation evidenced the presence of a system visually tracking expiration dates and ensuring that expired food items were being thrown out as needed. Leftovers from catered meals are being removed from the facility after a maximum of 48 hours. Visual inspection of the refrigerator found no currently expired items. A potential incident involving expired milk being consumed was brought up during interviews however other interviews conducted did not corroborate the exact circumstances of the incident.

Regarding the allegation that a Client medication was not refilled timely, the following has been concluded: Based on interviews and review of the facility's medication orders and medication administration records provided, it was determined that one client's inhaler was found to have expired upon admission and was replaced within a few days. The treatment was provided as a PRN and no evidence of a missed dose being provided as needed could be found. Another client's treatment was claimed to have been delayed however it was determined that the medication had not yet been prescribed at the time and was not the object of a required refill.

As a result, the three allegations listed above are found to be Unsubstantiated, meaning that although the allegations listed may have happened or are valid, there is not sufficient evidence to demonstrate that the alleged violations occurred.

An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2